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Home My WebLink AboutBrown & Brown (Humana)#1Group Health Insurance Employee Benefits Proposal For City of Sunny Isles Beach Miami - Dade County Florida Presented by: Robert P. Hollander Executive Vice - President Tel (305) 364 -7818 or (800) 432 -8844 Fax (305) 822 -5687 Date Submitted: November 29, 2000 BID # 00 -11 -01 Brown & Brown. Inca' i kW NOV 2 9 2000 �o,oc 1 City of Sunny Isles Beach REQUEST FOR PROPOSALS: GROUP HEALTH INSURANCE NOVEMBER 2000 • CITY OF SUNNY ISLES BEACH MIAMI -DADE COUNTY FLORIDA OFFICE OF THE CITY MANAGER BID # 00 -11 -01 Brown & Brown, Inc. Spessard Holland Bldg. Suite 400 8000 Governors Square Blvd. Miami Lakes, FL 33016 -1588 305/364 -7800 • Toll Free 800/432 -8844 FAX 305/822 -5687 INSURANCE November 28, 2000 Mr. Christopher Russo, City Manager City of Sunny Isles Beach 17070 Collins Avenue, Suite 250 Sunny Isles Beach, FL 33160 Re: Group Health Insurance Dear Mr. Russo, I am pleased to provide an Employee Benefit Proposal for the City of Sunny Isles Beach, FL. r Brown & Brown, Inc. Spessard Holland Bldg. Suite 400 8000 Governors Square Blvd. Miami Lakes, FL 33016 -1588 305/364 -7800 • Toll Free 800/432 -8844 FAX 305/822 -5687 INSURANCE November 28, 2000 Mr. Christopher Russo, City Manager City of Sunny Isles Beach 17070 Collins Avenue, Suite 250 Sunny Isles Beach, FL 33160 Re: Group Health Insurance Dear Mr. Russo, I am pleased to provide an Employee Benefit Proposal for the City of Sunny Isles Beach, FL. Brown & Brown Insurance, Inc., is the largest independent insurance agency in the State of Florida and currently the eighth largest in the nation. We are a public company and I am enclosing our 1999 Annual Report for your review. I have been in the insurance industry in South Florida for almost thirty -five years. I owned and operated Dade Underwriters Insurance Agency established in 1950 and previously located in Aventura, FL, providing all forms of insurance coverages and programs to business and individuals throughout South Florida. On January 1, 1997, I merged my agency with Brown & Brown Insurance, Inc., formerly known as Poe & Brown Insurance, Inc., and assumed the title of Executive Vice President. Our office is located at 8000 Governors Square Boulevard, Suite 400, Miami Lakes, FL 33016. The Miami Lakes office of Brown & Brown Insurance, Inc., employs thirty -seven insurance professionals and insures in excess of seven thousand businesses and individuals. We are fully staffed and experienced to provide the very finest employee benefit services to the City of Sunny Isles Beach and its employees. You will find attached to this letter a copy of my insurance licenses with the State of Florida and a selected listing of existing Brown & Brown Insurance, Inc., group health clients. Please feel free to contact any of these references, at your convenience. An important criteria of our proposal is the quality and financial ratings of the insurance carriers. As you can see by the attached Best's Insurance Reports, all of the insurance carriers represented in our proposal have a minimum rating of A- Excellent. I strongly suggest that strict financial criteria be required of all bidding insurance carriers. Page 2 November 28, 2000 Mr. Christopher Russo We have made every effort to conform to your coverage requests and bidding format. It is also our desire to offer viable alternatives to develop the most comprehensive and competitive program. In regard to the group health, you will note that various types of plans and premiums are offered by two carriers, Aetna USHealthcare, Inc., and Humana, Inc. Aetna USHealthcare, Inc., offers combinations of HMO, POS and US Access, an "Open Access" plan that does not require a referral from the primary care physician. Humana Inc. can combine the HMO with the PPO plan. The Humana, Inc., POS plan is not combinable with other plans. We are presenting an independent comprehensive Vision Plan with EyeMed, a division of Luxotica, Inc. The Dental Plan is proposed with Guardian Life Insurance Company of America. In order to determine the best plan, or combination of plans, it is important to carefully review the various benefit and premium summaries provided in the proposal. I will be delighted to personally review the benefit and premium details with you and your staff. I sincerely appreciate the opportunity to offer the services of Brown & Brown Insurance, Inc. to the City of Sunny Isles Beach. Very tail ours, /Robert P. Hollander Executive Vice President encl. • • • Best's Insurer Profile HUMANA HEALTH INSURANCE COMPANY FLORIDA, ( Group Affiliation: Humana Inc ) 76 South Laura Street, Jacksonville, Florida, United States 32202 Tel: 904 -296 -7908 Fax: 502 - 580 -4089 Mailing Address: P.O. Box 740036, Louisville, Kentucky, United States 40201 -7436 Exec. Office: 500 West Main Street, Louisville, Kentucky, United States 40202 http:Uwww. Humana.com Current Rating*: A- (Excellent) * As of I P27,7000 3:01:38 PAS/ Business Review F6�BiE t��} Iyseue Humana Health Insurance Company of Florida (Humana Health of Florida) is a wholly -owned subsidiary of Humana Inc., a leading provider of managed health care services. With approximately 5.9 million medical members, the Humana organization provides health products and services along the entire product spectrum, ranging from health maintenance organization (HMO), point of service (POS), preferred provider organization (PPO) and traditional indemnity coverage. The organization also provides specialty products and employee benefit designs such as: administrative services only (ASO, or fee - based /non -risk) products, government business including T.RICARE (contract to provide healthcare services to U.S. military dependents and retirees, formerly known as CHAMPUS), as well as the Federal Employee Program (FEP), life insurance, dental, disability, workers' compensation, and medical savings accounts (MSAs). During 1999, Humana realigned its organization to achieve greater accountability in its lines of business. As a result of the realignment, the company organized into two business units: the Health Plan segment and the Small Group Segment. The Health Plan segment includes the company's large group commercial (100 employees and over), Medicare, Medicaid, ASO, workers' compensation and military or TRICARE business. The small group Page 1 of 2 1µm' .......,..L;...i l Assigned to companies which have, on balance, excellent financial strength, operating performance and market profile when compared to the standards established by the A.M. Best Company. These companies, in our opinion, have a strong ability to meet their ongoing obligations to policyholders. Best's Ratings are recognized worldwide as the benchmark for assessing insurers' financial strength. A.M. Best's ratings reflect an in -depth knowledge of the insurance industry developed during its loo - year relationship with the business. This is one reason why insurance Best's Insurer Profile Page 2 of 2 business segment includes small group commercial (under 100 have consistently ranked employees) and specialty benefit lines, including dental, life and Best's Ratings number • short -term disability. one in confidence, usefulness and understanding. A.M. Best History Company is the leading Date Incorporated: 12/19/1983 Date Commenced: 05/01/1984 provider of ratings, news Domicile: FLMergers_ PCA Life Insurance Company, Florida, and financial information 1998. on the insurance industry. Its more than 50 publications and services satisfy the diverse needs The information contained in this profile is condensed from a more detailed of insurance and financial financial analysis report, order online or contact our Customer Service professionals for timely, department at (908) 439 -2200 ext. 5742. accurate and detailed information. © Copyright 2000 by A.M. Best Company, Inc. ALL RIGHTS RESERVED. No part of this report may be reproduced or distributed in any form or by DISCLAIMER: While any means, or stored in a database or retrieval system, without the prior the information obtained written permission of the A.M. Best Company. from these sources is believed to be reliable, its accuracy is not guaranteed. No representations or warranties are made or given as to the accuracy or completeness of the information presented • herein, and no responsibililty can be accepted for any error, omission or inaccuracy in our reports. CJ 0 Best's Insurer Profile HEALTHCARE FLORIDA CORPORATION) ( Group Affiliation: Aetna U.S. Healthcare, Inc. Group ) 5100 West Lemon Street, Ste. 218, Tampa, Florida, United States 33609 Tel: 813- 261 -9630 Mailing Address: P.O. Box 1109, Blue Bell, Pennsylvania, United States 19422 Exec. Office: 980 Jolly Road, Blue Bell, Pennsylvania, United States 19422 Current Rating *: A- (Excellent) (Under Review * As of 1 127'2000 3:01:38 PM �iyancral Strer�tq BEST lycelitor Business Review • Aetna U.S. Healthcare of Florida is a subsidiary of Aetna U.S. Healthcare. Aetna U.S. Healthcare is a wholly owned subsidiary of Aetna Inc. The Florida HMO reported an enrollment gain of 35% for year -end 1999. Membership is comprised of group commercial and medicare risk business. Aetna U.S. Healthcare of Florida has also reported a historical trend of negative earnings, with 1999 posting its highest losses. AETNA U.S. HEALTHCARE - Aetna U.S. Healthcare, operating as a subsidiary of Aetna Inc., is one of the nation's largest health benefits companies based on membership. Membership growth has primarily been a result of its aggressive acquisition strategy, specifically the Prudential Health Care and NYLCare Health Plan acquisitions. Total health membership is widely dispersed throughout the United States. Aetna U.S. Healthcare provides a full spectrum of health products (managed care, indemnity and prescription drug, dental and vision) and group insurance products (life, disability, and long -term care) on both an insured and an employer- funded basis. Under insured plans, the Company assumes all or a majority of health care cost, utilization, mortality, morbidity or other risk depending on the product. Under employer- funded plans, the plan sponsor, and not the Company, assumes all or a I* majority of these risks Page 1 of 2 Assigned to companies which have, on balance, excellent financial strength, operating performance and market profile when compared to the standards established by the A.M. Best Company. These companies, in our opinion, have a strong ability to meet their ongoing obligations to policyholders. Best's Ratings are recognized worldwide as the benchmark for assessing insurers' financial strength. A.M. Best's ratings reflect an in -depth knowledge of the insurance industry developed during its 100 - year relationship with the business. This is one reason why insurance Best's Insurer Profile Page 2 of 2 I� have consistently ranked • History Best's Ratings number Incorporated: 06/04/1984 Date Commenced: 07/01/1985 Date Ineor P one confidence, usefulness and Domicile: FL understanding. A.M. Best Company is the leading provider of ratings, news The it formation contained in this profile is condensed, from a more detailed and financial information financial analysis report, order Online or contact our Customer Service on the insurance industry. department at (908) 439 -2200 ext. 5742. Its more than 50 publications and services satisfy the diverse needs © Copyright 2000 by A.M. Best Company, Inc. ALL RIGHTS RESERVED. of insurance and financial No part of this report may be reproduced or distributed in any form or by professionals for timely, any means, or stored in a database or retrieval system, without the prior accurate and detailed written permission of the A.M. Best Company. information. DISCLAIMER: While the information obtained from these sources is believed to be reliable, its accuracy is not guaranteed. No representations or warranties are made or given as to the accuracy or completeness of the • information presented herein, and no responsibililty can be accepted for any error, omission or inaccuracy in our reports. I� • Best's Insurer Profile GUARDIAN INSURANCE COMPANY AMERICA ( Group Affiliation: Guardian Group ) 7 Hanover Square, New York, New York, United States 10004- 2616 Tel: 212- 598 -8000 Fax: 212- 598 -8815 http://www.glic.com Current Rating *: A+ (Superior) * As of 1 T/2 712000 3:01:38 PM We - al Sirpa � Ai BEST .. supeiriol Business Review • The Guardian Life Insurance Company of America is a mutual life insurance company with nearly $34 billion in total assets under management. The company issues primarily individual life and group insurance coverages through its career agency force and broker network. The company also has complementary affiliated operations including an asset management company, a registered broker - dealer, and a reinsurance broker. In addition, the company recently established a thrift institution which will offer trust and fiduciary services through Guardian's career agency force throughout the country. Guardian manages its operations through three primary profit centers: individual markets, group insurance and equity products. The company further segments its group operations into pensions and life reinsurance. INDIVIDUAL MARKETS - Guardian focuses its activities within this segment on the upper income life insurance and disability income market. Its broad product portfolio includes traditional whole life, term, and pension trust products, as well as the variable life and annuity products issued through The Guardian Insurance and Annuity Company (GIAC). In addition, through Guardian Investment Services Corp. (GISC), an affiliated broker- dealer, a full spectrum of investment products are available including the organization's proprietary mutual fund family, The Park Avenue Page 1 of 2 Assigned to companies which have, on balance, superior financial strength, operating performance and market profile when compared to the standards established by the A.M. Best Company. These companies, in our opinion, have a very strong ability to meet their ongoing obligations to policyholders. Best's Ratings are recognized worldwide as the benchmark for assessing insurers' financial strength. A.M. Best's ratings reflect an in -depth knowledge of the insurance industry developed during its 100 - year relationship with the business. This is one reason why insurance Best's Insurer Profile Funds Portfolio. In May 1999, Park Avenue Securities (PAS), a newly formed broker - dealer affiliate of GIAC, assumed the retail business of GISC. PAS offers mutual funds from The Park Avenue Portfolio, proprietary and non - proprietary variable annuity and variable life products, equity securities, and non - proprietary mutual funds. These insurance and investment offerings are marketed primarily in the upscale business - owner, professional and executive markets through the company's career agency force of over 2,300 soliciting agents, as well as independent agents and outside brokers. Guardian's career sales force has steadily grown over the last five years and the company's 4 year agent retention rate of 30% is almost double the industry average. This stability in the sales force provides a competitive advantage in the upper income market. The sales organization's strength and stability, as well as its focus on the upper income market, are evidenced by the fact that Guardian's average case size and average premium per policy is significantly higher than its peer group. History Date Incorporated: 04/10/1860 Date Commenced: 07/16/1860 Domicile: NY Originally incorporated as Germania Life Insurance Company, the • present title was adopted in 1918. The company was fully mutualized during 1945. The information contained in this profile is condensed from a more detailed financial analysis report, order online or contact our Customer Service department at (908) 439 -2200 ext. 5742. © Copyright 2000 by A.M. Best Company, Inc. ALL RIGHTS RESERVED No part of this report may be reproduced or distributed in any form or by any means, or stored in a database or retrieval system, without the prior written permission of the A.M. Best Company. • Page 2 of 2 have consistently ranked Best's Ratings number one in confidence, usefulness and understanding. A.M. Best Company is the leading provider of ratings, news and financial information on the insurance industry. Its more than 50 publications and services satisfy the diverse needs of insurance and financial professionals for timely, accurate and detailed information. DISCLAIMER: While the information obtained from these sources is believed to be reliable, its accuracy is not guaranteed. No representations or warranties are made or given as to the accuracy or completeness of the information presented herein, and no responsibililty can be accepted for any error, omission or inaccuracy in our reports. Brown az Brown, Inc., Wiami Lakes Account Servicing Team Our Employee Benefits Department has made a commitment to provide you with customer service you can depend on For all matters concerning your account the people to contact are: Robert Hollander Executive Vice - President Employee Benefits Tel.(305)364 -7818 or (800)432 -8844, ext.7818 Fax.(305)822 -5687 Samantha Alvarez Employee Benefits Customer Service Tel.(305)364 -7829 or (800)432 -8844, ext. 7829 Fax.(305)822 -5687 Brown & Brozvn. Inr_. 8120WjcV 6�. BWOW�V, INC. An Overvaew............ Brown & Brown is consistently among the top ten largest independent insurance agencies in the nation and is the largest such firm home based in Florida. With over sixty years of experience, our company serves customers with 18 offices in Florida, as well as offices in Arizona, California, Georgia, Indiana, Nevada, New Jersey, New Mexico, Ohio, Pennsylvania and Texas. The Brown & Brown offices are fully staffed to perform all the functions and duties of a full general insurance agency in the areas of Property, Casualty, Employee Benefits, Life, Long Term Care, Disability and full Bonding capabilities. We have been actively involved in Risk Management Consultation for over 20 years. Through the resources of our Management team and staff, combined with our in -house computer capability, an increasing number and broad range of clients receive professional insurance design, underwriting, reinsurance, administration, claims handling, loss control and excess and surplus lines placement. We take considerable pride in the fact that we are capable of meeting all of our clients requirements while still providing the personalized service necessary to design, implement and administer programs flexible enough to meet each clients special needs. BrOX11 & Bro -inn. TYIr BROWN & BROWN, INC. MIAMI EMPLOYEE BENEFITS DEPARTMENT OFFERS SEVERAL PROGRAMS INCLUDING: w HEALTH PLANS HMO's, PPG's, Traditional Indemnity, Dental -- Voluntary & Traditional Competitive Pricing and Coverage wLIFE INSURANCE Payroll Deduction, Individual Policies, Buy -Sell Agreements -DISABILITY INSURANCE Group and Individual, Disability Buy -Out Our Employee Benefits Department has made a commitment to provide the insured with quality customer service and is dedicated to meeting all of our clients' needs. We represent a wide range of national health and life insurance companies thus enabling us to provide our customers with the broadest range of employee benefit options and programs. Our Department acts as the liaison between the client and insurance companies to solve problems and get them resolved in a timely manner. The Benefits Department of Brown & Brown Miami Lakes is dedicated to excellent customer service and client satisfaction. Brown & Brown, Inc.' 0 BROWN & BROWN, INC. — SELECTED REFERENCES Bal Harbor 101 Condominium Association Thomas Hart, Property Manager — (305) 868 -7616 City of Holly Hill — (Contact name and phone number, upon request) City of Flagler Beach — (Contact name and phone number, upon request) City of Ocoee — (Contact name and phone number, upon request) Desert Hotels of Miami Beach dba Deze Properties Marla Weinman, Human Resources /Accounting — (305) 931 -7700 • Newport Beachside Hotel & Resort — Dr. Robert Cornfeld, owner Sheila Ramsey, VP — (305) 623 -9090 Turnberry Towers Condominium Association, Inc. Sandra Victores, Property Manager — (305) 935 -3000 Williams Island Associates, Ltd Patrick Powers, CFO — (305) 937 -7884 is • • U1, h P D EPA RT N I E N T 0 F I N I RAN CE ROBERT PAUL HOLLANDER License Number Al2,11581 IS LICENSED TO TRANSACT THE FOLLOWING CLASSES OF INSURANCE: This licensee -lust have an active appointment Vvith the insurer or employer for )rq_Ci U CtS or ser.,,ices are being marketed See reverse for additional ea o ;rer7-ei—Z. • 3 le SWORN STATEMENT PURSUANT TO SECTIO`i 287.133(3)(a) FLORIDA STATUTES. ON PUBLIC ENTITY CRIMES THIS FOR,%I MUST BE SIGNED AND SWORN TO IN THE PRESENCE OF A NOTARY PUBLIC OR OTHER OFFICIAL AUTHORIZED TO ADMINISTER OATHS. 1 . This s-,vom statement is submitted to City of Sunny Isles Beach by Robert P. Hollander for Brown & Brown Inc. whose business address is 8000 Governors Square Blvd., #400 Miami Lakes, FL 33016 and (if applicable) its Federal Employer Identification Dumber (FEIN) is 59- 0864469 (IF the entity had no FECN, include the Social Security Number of the individual signing this sworn statement: 1 understand that a "public entity crime" as defined in Paragraph 287.133(1)(g), Florida Statutes, means a violation of any state or federal law by a person with respect to and directly related to the transaction of business with any public entity or with an agency or political subdivision of any other state or of the United States, including, but not limited to, any bid or contract for goods or services to be provided to any public entity or an agency or political subdivision of any other state or of the United States and involving antitrust, fraud, theft, bribery, collusion, racketeering, conspiracy, or material misrepresentation. 3. 1 understand that "convicted" or "conviction" as defined in Paragraph 287.133(1)(b), Florida Statutes means a finding of guilt or a conviction of a public entity crime, with or without an adjudication of guilt, • in any federal or state trial court of record relating to charges brought by indictment or information after July 1, 1939, as a result of a jury verdict, nonjury trial, or entry of a plea of guilty or nolo contenders. I understand that an "affiliate" as defined in Paragraph 287.133(1)(a), Florida Statutes, means: l . A predecessor or successor of a person convicted of a public entity crime; or 2. An entity under the control of any natural person who is active in the management of the entity and who has been convicted of a public entity come. The term "affiliate" includes those officers, directors, executives, partners, shareholders, employees, members, and agents who are active in the management of an affiliate. The ownership by one person of shares constituting a controlling interest in another person, or a pooling of equipment or income among persons when not for fair market value under an arm's length agreement, shall be a prima facie case that one person controls another person. A person who knowingly enters into a joint venture with a person who has been convicted of a public entity crime in Florida during the preceding 36 months shall be considered an affiliate. 5. I understand that a "person" as defined in Paragraph 287.133(I)(e), Florida Statutes, means any natural person or entity organized under the laws of any state or of the United States with the legal power to enter into a binding contract and which bids or applies to bid on contracts for the provision of goods or services let by a public entity, or which otherwise transacts or applies to transact business with a public entity. The term "person" includes those officers, directors, executives, partners, shareholders, employees, members, and agents who are active in management of any entity. • �` \ 11/28/00 Signature Date • NON- COLLUSIVE AFFIDAVIT State of Florida )ss COUnty Of Miami -Dade Robert P. Hollander deposes and says that: being first duly sworn, (1) He /she is the(Owner, Partner, Officer, Representative or Agent) of the Bidder that has submitted the attached Bid; (2) He /she is fully informed respecting the preparation and contents of the attached Bid and of all pertinent circumstances respecting such Bid; (3) Such Bid is genuine and is not a collusive or sham Bid; • (4) Neither the said bidder nor any of its officers, partners, owners, agents, representatives, employees or parties in interest, including this affant, have in any way colluded, conspired, connived or agreed, directly or indirectly, with any other Bidder, firm, or person to submit a collusive or sham Bid in connection with the Work for which the attached Bid has been submitted; or to refrain from bidding in connection with such Work; or have in any manner, directly or indirectly, sought by agreement or collusion, or communication, or conference with any Bidder, firm, or person to fix the price or prices in the attached Bid or of any other Bidder, or to fix any overhead, profit, or cost elements of the Bid price or the Bid price of any other Bidder, or to secure through any collusion, conspiracy, connivance, or. unlawful agreement any advantage against the City of Sunny Isles Beach, or any person interested in the proposed Work; (5) The price or prices quoted in the attached Bid are fair and proper and are not tainted by any collusion, conspiracy, connivance, or unlawful agreement on the part of the Bidder or any other of its agents, representatives, owners, employees or parties in interest, including this affiant. 11 • CITY OF SUNNY ISLES BEACH CONE OF SILENCE "You are hereby advised that this invitation to bid is subject to the "Cone of Silence," in accordance with Miami -Dade County Ordinance #98 -106 and #99 -1. From the time of advertising until the City Manager issues his recommendation, there is a prohibition on communication with the City's professional staff. The Ordinance does not apply to oral communications at pre -bid conferences, oral presentations before evaluation committees, contract discussions during any duly noticed public meeting, public presentations made to the City Commission during any duly noticed public meeting, contract negotiations with the staff following the award of an RFP, RFQ, RFI or bid by any City Commission, or communications in writing at any time with any City employee, official or member of the • City Commission unless specifically prohibited. A copy of all written communications must be filed with the City Clerk. Violation of these provisions by any particular bidder or proposer shall render any RFP award, RFQ award, RFI award to said bidder or proposer void, and said bidder or proposer shall not be considered for any RFP, RFQ, RFI or bid for a contract for the provision of goods or services for a period of one year. Any questions or clarifications concerning this Invitation to Bid shall be submitted in writing, by mail or facsimile to the City Manager, 17070 Collins Ave. #250, Sunny Isles Beach, FL 33160, Fax: 305 1349 -3113. The-bid title /number shall be referenced on all correspenddence. A11 questions must be received no later than fifteen (15) caft d.a) clays prior to the scheduled bid opening date. All responses to questions/ clarifications will be sent to all prospective bidders in the form of an addendum. NO QUESTIONS WILL BE RECEIVED VERBALLY OR AFTER DEADLINE. The City of Sunny Isles Beach reserves the right to accept any proposal or bid deemed to be in the best interest of the City of Sunny Isles Beach, or waive any informality in any proposal or bid. The City of Sunny Isles Beach may reject any and all proposals or bids. is • • 0 iiumana" Health Care Plans overview ♦ Humana Health Care Plans is a multiple- option family of insurance and health plan products designed with the flexibility to meet the needs of today's rapidly evolving health care industry. A Since introduction in 1984, Humana Health Care Plans membership has grown steadily —and today there are more than 1.8 million members nationwide. ♦ Humana Health Care Plans serve members through a network of participating hospitals, participating physicians, and other participating health care providers. ♦ The savings attributed to our contracted health care delivery system are passed on to the client in the form of reduced rates. ♦ Because of our provider arrangements, we can offer your company: 1. Access to quality health services 2. Quality and cost control features 3. Long -term savings through managed care 4. Unique services for your employees not always available with traditional carriers. Humana refers to the Humana Inc. family ofcompanies. PROP 7/94 ox Humana's vision: to become the most trusted name in health solutions. *LJMANA. HUMANA SNAPSHOT What is Humana? Humana Inc., headquartered in Louisville, Kentucky, is one of the nation's largest publicly traded health services companies with approximately 5.9 million medical members located in 15 states and Puerto Rico. The company, founded in 1961, is traded on the New York Stock Exchange (NYSE: HUM) Humana offers coordinated health care coverage to employer groups and individuals through a variety of plans: Health maintenance organizations Preferred provider organizations Point -of- service plans Administrative services products Government- sponsored plans Plans for U.S. military dependents and retirees The company's specialty products of dental, life and disability insurance complement its core health offerings. Humana provides health insurance and related services to companies ranging from less than 10 to tens of thousands of employees. Humana's innovative wellness and chronic disease intervention programs have received national recognition in and outside the health care industry. Such recognition is consistent with Human's vision: to become the most trusted name in health solutions. E- business is transforming Humana's business model Five key strategic Internet relationships have reinforced Humana's leadership in e- health solutions and allowed Humana to begin moving numerous business transactions to the Internet for our members and physicians, from enrollment to claims payments. The TriZetto Group, Oracle, Healtheon /Web MD, Microsoft and Electronic Data Systems (EDS) each bring their own set of technological capabilities in assisting Humana to maximize the Internet for all its stakeholders and to transform its business model from managed care to health solutions. Humana has expanded its partnership with CorSolutions, a disease intervention company, to include Internet capabilities for its members. eCorSolutions is now available online for Humana members in disease intervention programs, enabling them to adhere more closely to treatment July 2000 regimens and to monitor their health status on a real -time basis In November 1999, PC Week named Humana the 29th most Web -savvy company in any industry in the U.S. Humana's key assets Membership strength of approximately 5.9 million provides the buying power to offer customers superior value. With 95 percent of its medical membership in 15 states and Puerto Rico, Humana has the market position that has enabled the company to develop excellent provider networks in its key markets. To serve its members, Humana contracts with 330,000 physicians and 2,500 hospitals through its ChoiceCare Network, one of the nation's largest. Humana contracts with 39,000 pharmacies across the nation and in Puerto Rico. Humana has strong capabilities to serve small businesses. More than 120,000 small businesses rely on Humana coverage, with an average size of nine employees. A network of independent agents backs up sales and service to small groups. Humana offers its members award - winning programs in preventive care, early intervention and chronic disease intervention. Providing solutions to our members' health problems Humana takes its members' health very seriously. The company puts extensive energy and resources into providing access to services that seek to help people get well and prevent them from getting sick in the first place. Members enrolled in Humana's end stage renal disease (ESRD) intervention program administered by RMS Disease Management Inc. exceeded national averages for expected outcomes.The RMS program results are measured against benchmarks established by the Health Care Financing Administration. Ninety-three percent of Humana members in the RMS program achieved or exceeded hemodialysis adequacy targets versus the national average of 78 percent. More than 1,500 members enrolled in Humana's congestive heart failure program (CHF) with an average enrollment of 12 and one half months. Eighty-eight percent of Humana members enrolled in the CHF program are on appropriate vasodilator medication, with 60 percent of members receiving Continued on back side humana.com commercial large group The gateway to an Internet-enabled, customer-focused health insurance company. At Humana, we're using the power of the Internet to make it easier for others to do business with us. Collaboration: a strategic advantage Through alliances with Microsoft®, Healtheon /WebMD'm, Oracle®, QualityMetrics, EDS, PPS and other leaders in the technology arena, we're introducing features that: speed the transfer of information and business processes to the Internet provide faster, easier access to humana.com features and functions help us remain competitive in today's fast - moving, technology- driven environment Easy access from every portal Humanaxom provides a portal for each of our audiences, enabling ready access to information and self - service features. From helping a benefits administrator seeking health plan information, to assisting a member inquiring about the status of a claim or responding to a broker requesting a plan quote, Humana's e- capabilities simplify the process. A new generation of e- health plans While introducing e- business functions into our existing health plans, we're developing a new generation of health plans expressly for the Internet. From paperless enrollment through online administration, the plans promise a faster, simpler, more efficient process. Expanding our e- business capabilities Humana was ranked 29th among the "Fast Track 500" of e- enabled companies (PC Week, November 15, 1999). Based on user experience and accessibility, Humana's Web site earned a ranking among the top eight in the health care industry (WebCriteria Industry Index; July 7, 2000). By constantly expanding our e- business capabilities, we're working toward improving efficiency and productivity for our agents and brokers, benefits managers, health plan members and network providers. 0 Commercial service areas HOLMES ACKSON BANTA ROSA _ _ WASHINGTON GADSDEN Q JEFFERSON HAMILTON , / CALM LIN SON. (PPOOMYI I f!w LIBERTY h:. WKULU f f I � SUWANNEE TAYLOR GULF I FRANKLIN 1---J "I I LAFAYETTE MARKET OFFICES: F71PENSACOLA Escambia, Santa Rosa s FT. WALTON Okaloosa, Walton, Bay w TALLAHASSEE (PCA Only) Gadsden, Leon, Wakulla, Jefferson, Madison Y GAINESVILLE Alachua, Bradford, Union, Columbia, Gilchrist, Levy, Marion, Putnam, Dixie ®JACKSONVILLE Duval, Clay, St. Johns, Nassau, Baker DAYTONA Volusia, Flagler, Brevard ORLANDO Lake, Seminole, Orange, Osceola BOCA RATON N. Broward, Palm Beach, Indian River, St. Lucie, Okeechobee, Martin, Highlands ®MIRAMAR S. Broward, Dade FT. MYERS Lee, Charlotte, Desoto, Hardee, Glades, Hendry, Collier TAMPA Citrus, Hernando, Pasco, Hillsborough, Pinellas, Manatee, Polk, Sarasota Humana not available Holmes, Washington, Jackson, Calhoun, Gulf, Liberty, Franklin, Taylor, Lafayette, Suwannee, Hamilton, Sumter, Monroe Market Office Location FL- 64494 -CF 5/99 `v MONROE 112 Pali The Choice is Yours One of the largest health care provider networks in the nation with more than 300,000 providers spanning 44 states and Ike District of Columbia. partners include: • 85,000 primary care physicians • 18,000 OB /GYN physicians • 149,000 specialists • 50,000 ancillary providers • 2,800 hospitals ChoiceCare Network Advantage Provider Choice and Accessibility • Extensive, robust network of providers, including, physician /hospital /ancillary network, retail pharmacy network, national transplant network, and disease management network. • National reciprocity means employees who work and travel outside their home network area can conveniently access in -plan benefits at any ChoiceCare Network provider location. • am— ChoiceCare Network Physicians • National Provider Verification Hotline at 1- 800 - 626 -2736. Choice -Based Btisiness Solutions for Reduced Hedical Care Costs • Disease management care solutions programs • Cost - effective provider contracting • Provider profiling Positive Health 0iitcomes • Disease management care solutions • Population health analysis • Network stability Choice=' HUMANA. N E T W 0 R K / Real -tinge Internet Access • Instant provider locator with Physician Finder • Personalized, on- demand directories — Directories on Demand • Provider files updated weekly • Future online physician credentialing and contracting ChoiceCare Network Philosophy The ChoiceCare Network is dedicated to providing customers with cost - effective health care management solutions in an easy- to -do- business -with culture. GN- 67109 -HH 6/00 • • • PROP 7/94 Coordination of benefits Humana benefits are coordinated with similar benefits under other group hospital and medical service plans. In no event will use of the coordination of benefits provision cause the company to pay more than it would have paid, if no other coverage was involved. If we are the secondary carrier, our benefit will be the difference between the primary carrier's payment and 100 percent of eligible charges. Your contract will explain coordination of benefits in more detail. Deductible credit for takeover groups Any deductible amounts accumulated by an insured person under the employer's current group plan will be credited toward any deductible amount such insured person (employee and /or their eligible dependents) must pay for "major medical expenses" under Humana. Any reduction of the Humana deductible will be based on the amount of same or similar covered expenses incurred in the same calendar year under the prior plan. This credit will not apply if the group plan is replacing an HMO plan. Dependent coverage Eligible dependents include the employee's spouse and unmarried children from date of birth to the end of the calendar year in *hich the child reaches the age of 25, provided the child is ependent upon the policyholder for support, lives in the household of the policyholder or is a full or part -time student. Pre - authorization requirement You (insured person) must receive pre- authorization to determine that each surgery, hospital admission and medical procedure /service meets our guidelines of reimbursable, medically necessary treatment. To obtain pre- authorization, you must present your identification card, which shows our toll -free pre - authorization telephone number, to the physician. Your physician must call for pre- authorization. If pre- authorization is not obtained, benefits may be reduced by 50 percent for the medically necessary services that were provided without authorization. You may be required to pay the entire cost of services you receive if authorization is denied, or if we later determine that the services weren't medically necessary or eligible for coverage. Skilled nursing facility Humana provides coverage in a skilled nursing facility each calendar year. Coverage for room and board is based on the facility's most common semi - private rate. Extension of coverage for totally disabled plan members Totally disabled employees or dependents may be covered for the disabling condition for a period of up to 12 months beyond the termination date of the plan. Home health care Humana covers home health care on a calendar year basis. Coverage is limited to our schedule of reasonable allowances. Maternity services If the plan your employer selected provides maternity benefits for employees and their eligible spouses, then those services will be provided on the same basis as any other illness. Check the exclusions in your certificate of insurance to determine if dependents are eligible for maternity coverage. Pre - admission testing Under Humana, pre- admission testing is fully covered at 100 percent. The deductible amount does not apply. Second surgical opinion Humana Health Care Plans provide full coverage for all second surgical opinions (including additional, not previously completed X -rays and laboratory tests). Second surgical opinions are not subject to a deductible. Spine and back disorders Coverage for spine and back disorders is limited to the benefits in the Certificate of Insurance. Waiting period for membership At the employer's option, new employees may be subject to a waiting period for membership in the plan. The provisions shown here are subject to change without notice. *Note: Check the exclusions in your Certificate of Insurance to determine if dependents are eligible for oratcrnity coverage. FL- 64006 -CF (Formerly GHC FL -1285) 5/99 Florida Your mental health benefit for PPO members South Florida Area L� Outpatient Services (Participating Providers) • You can choose from any of the Magellan Behavioral Health (MBH) participating providers for mental health services. These providers are listed in your Humana Participating Provider Directory. • Complete mental health and substance abuse treatment services are provided by MBH providers at a minimal cost to you. • Lifestyle management programs are also offered by MBH as a covered benefit, e.g., Smoking Cessation, Stress Management, and Weight Management. Emergency services are available 24- hours -a -day, 7- days -a -week. • Copayments are waived for outpatient services obtained through MBH providers; no claim forms need to be filled out. • There is no predetermined limit on the number of visits to MBH therapists. Outpatient Services (Nonparticipating Providers) • You may choose a licensed mental health provider who is not participating with MBH. However, you will be responsible for the copayments and deductibles as shown on your Humana "Schedule of Benefits" Only medically necessary services are covered. • FL- 65129 -BC 9/99 • If you choose a nonparticipating provider for outpatient treatment and require more than three (3) visits, there will be a review process between your treating provider and MBH. The provider will advise MBH of the diagnosis and of the current and recommended treatment plan. This process results in better planning between you and the provider and also allows for prompt payment. Inpatient Services (Precertification is required for all hospital admissions.) • Psychiatric and substance abuse (detoxification) admissions must be precertified to guarantee coverage by your insurance. MBH's clinical staff evaluates these admissions for medical necessity. • MBH psychiatrists and psychologists coordinate and oversee hospital treatment. • MBH arranges intensive post- discharge aftercare and any other appropriate treatment for patients leaving the hospital. • Regular copayments and limits for inpatient services apply, as shown in your Humana "Schedule of Benefits." For more information or to schedule an appointment please call: (9 Magellan Behavioral Health 1- 800 - 741 -1017 articipating pharmacy coverage Your pharmacy coverage includes a three -tier copayment benefit. This means that when you present your membership card at a participating pharmacy, you will be required to make a copayment for your prescriptions based on the type of medication you purchase: • For a generic drug on the formulary, you will make a $5 copayment for a maximum 30 -day supply. • For a brand -name drug on the formulary, when a generic equivalent is not available, you will make a $15 copayment for a maximum 30 -day supply.* • For a drug that is not on the formulary and a generic equivalent is not available, you will make a $30 copayment for a maximum 30 -day supply.* There are no claim forms to file if you present your membership card with each prescription. Nonparticipating pharmacy coverage You may also purchase prescribed medications from a nonparticipating pharmacy.You will be required to pay for your iou iptions according to the following rule: pay 100 percent of the actual charges. - You file a claim form with Humana (address is on the back of ID card). - Claim is paid at 70 percent of the actual charges, after they are first reduced by the applicable copayment and any required difference in the cost between a brand - name medication and a generic medication. Coverage specifics Your coverage includes the following: • A 30 -day supply or the amount prescribed, whichever is less • Oral contraceptives • Self - administered injectable drugs approved by Humana will be paid at the applicable copayment. • Drugs, medicines or medications that under federal or state law may be dispensed only by prescription from a physician Formulary The Humana formulary is a comprehensive list that includes more than 850 brand -name and generic drug products that are approved by Humana and are available for use by members as a medication covered by their health care plan. It was developed and is maintained by a medical committee comprised of physicians and pharmacists. The formulary consists of medications chosen for their safety, effectiveness and affordability. If you purchase a prescribed medication that is not included on the formulary, you will pay the applicable copayment. Information about the Humana drug formulary is available to members by contacting a customer service representative at 1- 800- 4HUMANA (1- 800 - 448 - 6262). For a complete listing of participating pharmacies, please refer to your participating provider directory. fv z 1l order beg ie For your convenience, you may receive a maximum 90 -day supply of a prescribed maintenance medication for the cost of three applicable copayments per maximum 90 -day supply:* $15 generic /$45 brand /$90 non - formulary Please refer to the mail order brochure for a more detailed description of mail order benefits. 0 an available, generic medications will be used to fill your prescriptions. If you prefer or your physician prefers a brand -name medication when its generic lent is available, you must pay 100 percent of the difference in cost between the brand -name medication and generic as well as the applicable generic copayment. If no generic equivalent is available, you will receive the brand -name prescription for the applicable copayment. FL- 65891 -HH 3/99 Offered and Underwritten by Humana Insurance Company of Florida, Inc. ©1999 Humana Inc. All group sizes (continued on back) • Available with HumanaPPO Plan 57 This rider is made a part of the Group Policy to which it is attached. Benefits If you or your covered dependent(s) incur expenses for a routine exam or annual physical exam, the associated routine laboratory and x -ray charges will be covered at 100 percent; benefit payable up to a two hundred dollar ($200) maximum per calendar year. Exclusions Expense incurred will not be payable under this provision for the following: 1. Medical examination and related expenses for treatment or diagnosis of a bodily injury or sickness 2. Medical examination or associated diagnostic laboratory charges caused by or resulting from pregnancy 3. Eye examination for the purpose of prescribing corrective lenses 4. Hearing tests 5. Dental examinations 6. Expenses incurred under this benefit while you are confined in a Hospital or Ambulatory Surgical Center 7. Expenses incurred for an employment physical or exams for the purpose of obtaining insurance; and 8. Immunizations Offered by Humana Health Insurance Company of Florida, Inc. FL- 64701 -HH 01998 Humana Inc. 5/98 • • • PROP 7/94 Coordination of benefits Humana benefits are coordinated with similar benefits under other group hospital and medical service plans. In no event will use of the coordination of benefits provision cause the company to pay more than it would have paid, if no other coverage was involved. If we are the secondary carrier, our benefit will be the difference between the primary carrier's payment and 100 percent of eligible charges. Your contract will explain coordination of benefits in more detail. Deductible credit for takeover groups Any deductible amounts accumulated by an insured person under the employer's current group plan will be credited toward any deductible amount such insured person (employee and /or their eligible dependents) must pay for "major medical expenses" under Humana. Any reduction of the Humana deductible will be based on the amount of same or similar covered expenses incurred in the same calendar year under the prior plan. This credit will not apply if the group plan is replacing an HMO plan. Dependent coverage Eligible dependents include the employee's spouse and unmarried children from date of birth to the end of the calendar year in hich the child reaches the age of 25, provided the child is ependent upon the policyholder for support, lives in the household of the policyholder or is a full or part -time student. Pre - authorization requirement You (insured person) must receive pre - authorization to determine that each surgery, hospital admission and medical procedure /service meets our guidelines of reimbursable, medically necessary treatment. To obtain pre- authorization, you must present your identification card, which shows our toll -free pre - authorization telephone number, to the physician. Your physician must call for pre- authorization. If pre- authorization is not obtained, benefits may be reduced by 50 percent for the medically necessary services that were provided without authorization. You may be required to pay the entire cost of services you receive if authorization is denied, or if we later determine that the services weren't medically necessary or eligible for coverage. Skilled nursing facility Humana provides coverage in a skilled nursing facility each calendar year. Coverage for room and board is based on the facility's most common semi - private rate. Extension of coverage for totally disabled plan members Totally disabled employees or dependents may be covered for the disabling condition for a period of up to 12 months beyond the termination date of the plan. Home health care Humana covers home health care on a calendar year basis. Coverage is limited to our schedule of reasonable allowances. Maternity services If the plan your employer selected provides maternity benefits for employees and their eligible spouses, then those services will be provided on the same basis as any other illness. Check the exclusions in your certificate of insurance to determine if dependents are eligible for maternity coverage. Pre - admission testing Under Humana, pre- admission testing is fully covered at 100 percent. The deductible amount does not apply. Second surgical opinion Humana Health Care Plans provide full coverage for all second surgical opinions (including additional, not previously completed X -rays and laboratory tests). Second surgical opinions are not subject to a deductible. Spine and back disorders Coverage for spine and back disorders is limited to the benefits in the Certificate of Insurance. Waiting period for membership At the employer's option, new employees may be subject to a waiting period for membership in the plan. The provisions shown here are subject to change without notice. *Note: Check the exclusions in your Certificate of Insurance to determine if dependents are eligible for 9aternity coverage. FL- 66126 -HH (Formerly GHC FL -1285) 5/99 Florida Your mental health benefit for POS members South • Area Outpatient Services (Participating Providers) • You can choose from any of the Magellan Behavioral Health (MBH) participating providers for mental health services. These providers are listed in your Humana Participating Provider Directory. • Complete mental health and substance abuse treatment services are provided by MBH providers at a minimal cost to you. • Lifestyle Management Programs are also offered by MBH as a covered benefit, e.g., Smoking Cessation, Stress Management, and Weight Management. Emergency services are available 24- hours -a -day; 7- days -a -week. • Copayments and deductibles are waived for outpatient services obtained through MBH providers; no claim forms need to be filled out. • There is no predetermined limit on the number of visits to MBH therapists. Outpatient services (Nonparticipating Providers) • You may choose a licensed mental health provider who is not participating with MBH. However, you will be responsible for the copayments and deductibles as shown on your Humana "Schedule of Benefits." Only medically necessary services are covered. FL- 65168 -BC 9/99 • If you choose a nonparticipating provider for outpatient treatment and require more than three (3) visits, there will be a review process between your treating provider and MBH. The provider will advise MBH of the diagnosis and of the current and recommended treatment plan. This process results in better planning between you and the provider and also allows for prompt payment. Inpatient Services (Precerti cation is required for all liospital admissions.) • Psychiatric and substance abuse (detoxification) admissions must be precertified to guarantee coverage by your insurance. MBH's clinical staff evaluates these admissions for medical necessity. • MBH psychiatrists and psychologists coordinate and oversee hospital treatment. • MBH arranges intensive post- discharge aftercare and any other appropriate treatment for patients leaving the hospital. • Regular copayments and limits for inpatient services apply, as shown in your Humana "Schedule of Benefits" For more information or to schedule an appointment please call: Magellan 1�ehal, oml Health 1- 800 - 741 -1017 Participating pharmacy coverage Your pharmacy coverage includes a three -tier copayment benefit. This means that when you present your membership card at a participating pharmacy, you will be required to make a copayment for your prescriptions based on the type of medication you purchase: • For a generic drug on the formulary, you will make a $5 copayment for a maximum 30 -day supply. • For a brand -name drug on the formulary, when a generic equivalent is not available, you will make a $15 copayment for a maximum 30 -day supply.* r!� • For a drug that is not on the formulary and a generic equivalent is not available, you will make a $30 Formulary copayment for a maximum 30 -day supply.* There are no claim forms to file if you present your membership card with each prescription. Nonparticipating pharmacy coverage You may also purchase prescribed medications from a onparticipating pharmacy.You will be required to pay for our prescriptions according to the following rule: • You pay 100 percent of the actual charges. -You file a claim form with Humana (address is on the back of ID card). - Claim is paid at 70 percent of the actual charges, after they are first reduced by the applicable copayment and any required difference in the cost between a brand -name medication and a generic medication. Coverage specifics Your coverage includes the following: • A 30 -day supply or the amount prescribed, whichever is less • Oral contraceptives • Self- administered injectable drugs approved by Humana will be paid at the applicable copayment • Drugs, medicines or medications that under federal or state law may be dispensed only by prescription from a physician. The Humana formulary is a comprehensive list that includes more than 850 brand -name and generic drug products that are approved by Humana and are available for use by members as a medication covered by their health care plan. It was developed and is maintained by a medical committee comprised of physicians and pharmacists. The formulary consists of medications chosen for their safety, effectiveness and affordability. If you purchase a prescribed medication that is not included on the formulary, you will pay the applicable copayment. Information about the Humana drug formulary is available to members by contacting a customer service representative at 1- 800- 4HUMANA (1- 800 - 448 - 6262). For a complete listing of participating pharmacies, please refer to your participating provider directory. Mail order benefit For your convenience, you may receive a maximum 90 -day supply of a prescribed maintenance medication for the cost of three applicable copayments per maximum 90- day supply:* $15 generic /$45 brand /$90 non - formulary Please refer to the mail order brochure for a more detailed description of mail order benefits. *When available, generic medications will be used to fill your prescriptions. If you prefer or your physician prefers a brand -name medication when s generic equivalent is available, you must pay 100 percent of the difference in cost between the brand -name medication and generic as well as the plicable generic copayment. If no generic equivalent is available, you will receive the brand -name prescription for the applicable copayment. Offered and Underwritten by Humana Insurance Company of Florida, Inc. All group sizes FL- 65887 -HH 3/99 ©1999 Humana Inc. (continued on back) • • • PROP 7/94 The following provisions are common to all Humana"' ' Medical Plan, Inc. options: Coordination of benefits Humana plan coverage is coordinated with similar benefits under other group hospital and medical service plans. In no event will use of the coordination of benefits provision cause Humana to pay more than it would have paid if no other coverage was involved. Your contract will explain coordination of benefits in more detail. Dependent coverage Eligible dependents include the employee's spouse and unmarried children. Check your Certificate of Coverage for details. Eligibility umana plans are available to members of groups where formal employer - employee relationship exists. Skilled nursing facility Humana provides coverage of non - custodial care in a skilled nursing facility up to 100 days per lifetime (prior plan approval required). Coverage for room and board is based on the facility's most common semi - private rate. Extension of coverage for totally disabled plan members If a member is continuously totally disabled when we terminate the Group Plan — due to an illness or injury that began while the contract was in effect — we will continue to cover services related to the injury or illness until: • the member is no longer continuously totally disabled; • the member becomes covered by any medical insurance or health services plan carried or sponsored by the employer that does not have limitations regarding the disabling condition; • the last day of the twelve -month period following the date we terminate the Group Plan; or the plan limitations have been reached. Home health care Humana provides home health care services (prior plan approval required). Coverage is limited to our schedule of reasonable costs. Maternity services If the plan your employer selected provides maternity services for employees and their eligible dependents, then those services will be provided on the same basis as coverage payable for any other covered condition. Health services are not extended to a child born as a result of a pregnancy that existed when the Group Plan was terminated. Pre - admission testing Under Humana plans preadmission testing is covered at 100 percent if ordered by a participating provider. Second medical opinion Humana may provide full coverage for qualified second medical opinions (including additional, not previously completed X -rays and laboratory tests). Waiting period for membership At the employer's option, new employees may be subject to a waiting period for membership in the Plan. The provisions shown here are subject to change without notice. Your mental health benefit for HMO members South Florida Area Outpatient Services • Complete mental health and substance abuse treatment services are provided by MBH providers at a minimal cost to you. • Lifestyle management programs are also offered by MBH as a covered benefit, e.g., Smoking Cessation, Stress Management, and Weight Management. • Emergency services are available 24- hours -a -day, 7- days -a -week. • Copayments and deductibles are waived for any outpatient services obtained through MBH providers • There is no predetermined limit on the number of visits to MBH therapists. • You do not need a referral from your Primary Care Physician (though we will be glad to accept one if you prefer to be referred by a Primary Care Physician or your Employee Assistance Professional) • FL- 65167 -BC 9/99 Inpatient Services Precertification is required for all hospital admissions. • Psychiatric and substance abuse (detoxification) admissions must be precertified to guarantee coverage by your insurance. MBH's clinical staff evaluates these admissions for medical necessity. • MBH psychiatrists and psychologists coordinate treatment in the hospital and follow -up outpatient care. • MBH arranges intensive post- discharge aftercare and any other appropriate treatment for patients leaving the hospital. • Regular copayments and limits for inpatient services apply, as shown in your Humana "Schedule of Benefits ." For more information or to schedule an appointment please call: (9 Magellan B haiion I Health 1- 800 - 741 -1017 Participating pharmacy coverage Your pharmacy coverage includes a three -tier copayment benefit. This means that when you present your membership card at a participating pharmacy, you will be required to make a copayment for your prescriptions based on the type of medication you purchase: • For a generic drug on the formulary, you will make a $5 copayment for a maximum 30 -day supply. • For a brand -name drug on the formulary, when a generic equivalent is not available, you will make a $15 copayment for a maximum 30 -day supply.* • For a drug that is not on the formulary and a generic equivalent is not available, you will make a $30 copayment for a maximum 30 -day supply.* There are no claim forms to file if you present your membership card with each prescription. Coverage specifics Your coverage includes the following: A 30 -day supply or the amount prescribed, whichever is less • Oral contraceptives • Self- administered injectable drugs approved by Humana will be paid at the applicable copayment • Drugs, medicines or medications that under federal or state law may be dispensed only by prescription from a physician. Formulary The Humana formulary is a comprehensive list that includes more than 850 brand -name and generic drug products that are approved by Humana and are available for use by members as a medication covered by their ;:!n-A 7!:; health care plan. It was developed and is maintained by a medical committee comprised of physicians and pharmacists. The formulary consists of medications chosen for their safety, effectiveness and affordability. If you purchase a prescribed medication that is not included on the formulary, you will pay the applicable copayment. Information about the Humana drug formulary is available to members by contacting a customer service representative at 1- 800- 4HUMANA (1- 800 - 448 - 6262). For a complete listing of participating pharmacies, please refer to your participating provider directory. If you use a nonparticipating pharmacy, there is no coverage, except for prescriptions required during an emergency. Mail order benefit For your convenience, you may receive a maximum 90 -day supply of a prescribed maintenance medication for the cost of three applicable copayments per 90 -day supply:* $15 generic /$45 brand /$90 non - formulary Please refer to the mail order brochure for a more detailed description of mail order benefits. When available, generic medications will be used to fill your prescriptions. If you or your physician prefer a brand -name medication when its neric equivalent is available, you must pay 100 percent of the difference in cost between the brand -name medication and generic as well as the applicable generic copayment. If no generic equivalent is available, you will receive the brand -name prescription for the applicable copayment. FL- 65879 -HH 3/99 Offered by Humana Medical Plan, Inc. ©1999 Humana Inc. All group sizes (continued on back) 0 Executive Summary Visit our website: www.aetnaushc.com Section 1 - Executive Summary 1 City of Sunny Isles • Experience Aetna U.S. Healthcare° - -as the nation's leading provider of health and related benefits -- strives to use our insight, expertise and resources to meet the needs of the evolving health care market. But it is not mere size that differentiates us in the marketplace. It is an appreciation for what matters to our customers -- offering a complete array of products, a commitment to quality, strength in provider networks and the ability to use today's technology to enhance and simplify the way we do business. Products Featuring choice, flexibility and administrative ease We offer a complete array of products and programs that features choice, flexibility and administrative ease. Medical ; tlentah:. Ancillary Group Plans: Plan.• Insurance • HMO* HMO Vision • Group Life • • QPOS (Quality Point • PPO • Pharmacy • Short Term of Service)* • Freedom -of- Disability • USAccess (triple Choice • Long Term option)* • Dual Option Disability • POS • Indemnity • Managed • PPO Disability • Indemnity • Medicare + Choice • Affordable HealthChoices from Aetna U.S. Healthcare' supplemental hospital indemnity policy *These plans feature Safety Net, which offers extended medical coverage to employees who have been terminated without cause due to • layoff. (availability varies by state) Visit our website: www.actnaushc.com 11/17/2000 Section I - Executive Summary • City of Sunny Isles • • Programs Emphasizing wellness Most Aetna U.S. Healthcare plans continue to feature outreach, disease management and wellness programs, each promoting prevention, education and individualized attention to the special needs of members. The following programs are also included in these plans at no additional cost: 1 Informed Health° Line — toll -free access to nurses who can provide general health information 24 hours a day Natural Alternatives special rates on alternative therapies and products A Fitness program — special health club membership rates and discounts on home exercise equipment Networks Promoting easy access Our networks give members easy access to participating providers, hospitals and pharmacies. Across the United States, we have extensive, locally managed networks adding up to over 350,000 providers: - 3,000 hospitals - 90,000 PCPs - 215,000 specialists - 48,000 pharmacies (including Puerto Rico and U.S. Virgin Islands) Network reciprocity allows members in one network service area to access care in any other similar network service area across the country. Therefore, members who travel have access to care without penalty when away from home, subject to specific plan requirements. it our website: www.actnaushc.com 11/17/2000 is Section 1 - Executive Summary 3 City of Sunny Isles With Our Thanks Technology Sinipliffing service e.Health from Aetna U.S. Healthcare- is a business program that gives customers and members better access capabilities and promotes a paperless, efficient, real -time processing environment. e.Health uses innovative technologies to gather, analyze and distribute information in new ways ... and to put that information to work for our customers, members and providers. We appreciate the opportunity to present this proposal. In it, you will find information about how we can help you achieve your benefits program goals. If you are seeking an employee benefits package that offers value plus innovation, Aetna U.S. Healthcare is the right choice. This is only a brief summary of benefits available. Some restrictions may apply. For more specific information about coverage details, including limitations, exclusions, and other plan requirements, please contact your Aetna U.S. Healthcare sales representative. When included in your plan, Informed Health Line nurses cannot diagnose, prescribe or give medical advice. Contact vour physician first with any questions or concerns regarding your health care needs. Members are responsible for payment for all services or products received through the Natural Alternatives program. Aetna U.S. Healthcare has not credentialed or reviewed program providers or vendors for quality. Program providers are solely responsible for the products and services provided under the program and encourage members to consult their physician to determine what therapies meet their needs. Not all products offered by program vendors are offered on a reduced -rate basis. Aetna U.S. Healthcare does not endorse any vendor, product, or service associated with the program. Visit our website: www.aetnaushc.com 11/17/2000 • • Leading the Industry in Technology and Health Information Visit our website: www.aetnaushc.com Section 2 - Leading the Industry 1 City of Sunny Isles Technology and Health Information Maximizing technology to accelerate, simplify and streamline the way we do business is one of our highest priority initiatives. We call it e.Health from Aetna U.S. Healthcare "' Specifically, e.Health: A Is a portfolio of initiatives that demonstrates our commitment to and leadership in technology A Gives customers and members better access capabilities, and promotes a paperless, real -time, processing environment A Uses innovative technologies to gather, analyze, and distribute information in new ways and to put that information to work for our customers, members, and providers A Employs Internet technology to enable consumers, providers and plan sponsors to interact with us, our services and products A, Is designed to meet the needs of our various constituents today and well into the future e.Health Capabilities A Doc Find`- Our online directory of participating providers that makes it easy for members to find up to date provider information they need. A e.Plan Sponsor Monitor'ry — An electronic tool that lets plan sponsors monitor their claim and financial reports through the Internet to help them evaluate and better manage their health benefits programs. Level I access (standard reports) is available to 250+ life- cases. Level II (preformatted reports) and Level III (adhoc inquiry) are designed for large Key Account and National Accounts. 1. A E -Pay — An electronic referral and claims payment system that helps us attract and retain skilled network providers by ensuring • rapid processing and resolution of all valid electronic claims. Visit our website: www.actnaushc.com 11/17/2000 • Section 2 - Leading the Industry 2 City of Sunny Isles A EZConnect — A secure web -based solution for transporting enrollment and benefit files from a customer to Aetna U.S. Healthcare. A EZenroll — An Internet -based application that allows plan sponsors to make online enrollment and eligibility changes. A, EZLink N— Our web -based benefits and HR administration solution that provides online eligibility, enrollment, account maintenance, billing and reporting. EZLink simplifies benefits management and _rg minimizes paperwork for plan sponsors. A IntehHealth.'— A consumer website that includes current health care news, information, and search capabilities (www.intelihealth.com); won the 1999 Webby Award for best health site on the Internet. Tow ` - A www.aetnaushc.com — Our own website, stocked with up -to -the minute product, health and wellness information for consumers and members. Our technological focus presents many opportunities for our customers. As we continue to make progress in this area, additional initiatives will be designed to increase the ease and efficiency of administrative processes. Visit our website: www.actnaushc.com 1 1/17/2000 • 0 Proposed Benefits • Visit our website: www.aetnaushc.com Section 3 - Proposed Benefits 1 is City of Sunny Isles Health Maintenance Organization (HMO) Provider Network Yes PCP required/role PCP selection required/PCP provides routine care and coordinates all specialty referrals. Member cost sharing - Copay applies to all covered services rendered, coordinated or referred by a PCP - Copay percentage may apply on inpatient hospital stays and outpatient surgical services; annual out -of- pocket maximum limits member's financial risk Claim forms required No Available funding Full- risk, prospectively rated; also available options self- funded for 250+ life groups 0 Includes* • A Healthy Outlook Program A External Review Policy A Fitness Program A Informed Health® Line A Member Health Education A Women's Health for Life Programs Options* A Employee Assistance Program ♦ National Medical Excellence Program A Natural Alternatives- A Safety Net A Vision One® discount program *Described in the Programs section of this proposal; brochures also available from your Aetna U.S. Healthcare representative. HMO benefits are provided or administered by: Aetna U.S. Healthcare, Inc., Aetna U.S. Healthcare, Inc. (DE), Aetna U.S. Healthcare of California, Inc- Aetna U.S. Healthcare of the Carolinas, Inc., Aetna U.S. Healthcare of Georgia, Inc., Aetna U.S. Healthcare of Illinois, Inc., and/or Aetna U.S. Healthcare of North Texas, Inc. Visit our website: www.actnaushc.com 11/17/2000 Section 3 - Proposed Benefits 2 • City of Sunny Isles 0 Aetna U.S. Healthcare is a for - profit HMO. This material is for informational purposes only and is neither an offer of coverage nor medical advice. It contains only a partial, general description of plan or program benefits and does not constitute a contract. Consult your Group Agreement to determine governing contractual provisions, including procedures, exclusions and limitations relating to your plan. All the terms and conditions of your plan or program are subject to applicable laws, regulations and policies. The availability of a plan or program may vary by geographic service area. All benefits are subject to coordination of benefits. Aetna U.S. Healthcare does not provide health care services, and therefore cannot guarantee any results or outcomes. Participating providers are independent contractors in private practice and are neither employees nor agents of Aetna U.S. Healthcare or its affiliates. The availability of any particular provider cannot be guaranteed, and provider network composition is subject to change without notice. Certain providers may be affiliated with an Independent Practice Association (IPA), a Physician Medical Group (PMG), an integrated delivery system or other provider groups. Members who select these providers will generally be referred to specialists and hospitals within that system or group. Informed Health Line nurses cannot diagnose, prescribe or give medical advice. Contact your physician first with any questions or concerns regarding your health care needs. The Vision One discount program may be in addition to plan benefits. Providers are solely responsible for the products and services provided under the program. Aetna U.S. Healthcare does not endorse any vendor, product, or service associated with the program. Vision One is a registered trademark of Cole Vision Corporation. Members are responsible for payment for all services or products received through the Natural Alternatives program. Aetna U.S. Healthcare has not credentialed or reviewed program providers or vendors for quality. Program providers are solely responsible for the products and services provided under the program and encourage members to consult their physician to determine what therapies meet their needs. Not all products offered by program vendors are offered on a reduced -rate basis. Aetna U.S. Healthcare does not endorse any vendor, product or service associated with the programs. While this material is believed to be accurate as of the print date, it is subject to change without notice. In case of conflict between your plan documents and this information, the plan documents will govern. Visit our website: www.aetnaushc.com 11/17/2000 Section 3 - Proposed Benefits 3 City of Sunny Isles Quality Point of Service (QPOS®) Provider network Yes PCP required/role PCP selection encouraged/PCP can render and coordinate care, and make specialty referrals; members may self -refer to any recognized in- network or out -of- network provider Member cost sharing - Copay applies to all covered services rendered, coordinated or referred by a PCP - Referred copay percentage may apply on inpatient hospital stays and outpatient surgical services; annual referred out -of- pocket maximum limits member's financial risk - Deductible/coinsurance applies to all self- referred; in- network or out-of- network covered services Claim forms required Possible for self - referred services Available funding Full -risk, prospectively rated; also available x options self-funded for 250+ life groups Includes* 1 Healthy Outlook Program A External Review Policy Fitness Program A Informed Health" Line A Member Health Education Options* A National Medical Excellence Program ®. L Natural Alternatives" Program A Safety Net A Vision One °discount program A Women's Health for Life Programs A Employee Assistance Program •*Described in the Programs section of this proposal; brochures also available from your Aetna U.S. Healthcare representative. QPOS referred benefits may be provided or administered by: Aetna U.S. Healthcare, Inc., Aetna U.S. Healthcare, Inc. (DE), Aetna U.S. Healthcare of California, Inc., Aetna U.S. Healthcare of the Carolinas, Inc., Aetna U.S. Healthcare of Georgia, Inc., Aetna U.S. Healthcare of Illinois, Inc., Aetna U.S. Healthcare of North Texas, Inc, Aetna U.S. Healthcare of Washington, Inc. Visit our website: www.actnaushc.com 11/17/2000 Section 3 - Proposed Benefits 4 City of Sunny Isles QPOS self- referred benefits may be provided or administered bv: Aetna U.S. Healthcare, Inc., Aetna U.S. Healthcare of California, Inc., Aetna U.S. Healthcare of the Carolinas, Inc., Aetna U.S. Healthcare of Washington, Inc., Aetna Life Insurance Company, U.S. Health Insurance Company, and/or Corporate Health Insurance" Company. Aetna U.S. Healthcare is a for -profit HMO. This material is for informational purposes only and is neither an offer of coverage nor medical advice. It contains only a partial, general description of plan or program benefits and does not constitute a contract. Consult your Group Agreement and Group Policy to determine governing contractual provisions, including procedures, exclusions and limitations relating to your plan. All the terms and conditions of your plan or program are subject to applicable laws, regulations and policies. The availability of a plan or program may vary by geographic service area. All benefits are subject to coordination of benefits. Aetna U.S. Healthcare does not provide health care services, and therefore cannot guarantee any results or outcomes. Participating providers are independent contractors in private practice and are neither employees nor agents of Aetna U.S. Healthcare or its affiliates. The availability of any particular provider cannot be guaranteed, and provider network composition is subject to change without notice. Certain providers may be affiliated with an Independent Practice Association (IPA), a Physician Medical Group (PMG), an integrated delivery system or other provider groups. Members who select these providers will generally be referred to specialists and hospitals within that system or group. Informed Health Line nurses cannot diagnose, prescribe or give medical advice. Contact your physician first with any questions or concerns regarding your health care needs. The Vision One discount program may be in addition to plan benefits. Providers are solely responsible for the products and services provided under the program. Aetna U.S. Healthcare does not endorse any vendor, product, or service associated with the program. Vision One is a registered trademark of Cole Vision Corporation. Members are responsible for payment for all services or products received through the Natural Alternatives program. Aetna U.S. Healthcare has not credentialed or reviewed program providers or vendors for quality. Program providers are solely the responsible for the products and services provided under the program and encourage members to consult their physician to • determine what therapies meet their needs. Not all products offered by program vendors are offered on a reduced -rate basis. Aetna U.S. Healthcare does not endorse any vendor, product or service associated with the programs. While this material is believed to be accurate as of the print date, it is subject to change without notice. In case of conflict between your plan documents and this information, the plan documents will govern. • Visit our website: www.aetnaushc.com 11/17/2000 Section 3 - Proposed Benefits 5 • City of Sunny Isles USAccess® Provider network Yes PCP required/role PCP selection encouraged/PCP can render and coordinate care, and make specialty referrals; members may self -refer to any recognized in- network or out -of- network provider Member cost sharing - Copay applies to all covered services rendered, coordinated or referred by a PCP - Higher copay /coinsurance applies to all in- network, self - referred covered services - Deductible /coinsurance applies to all self- referred, out -of- network covered` services Claim forms required Possible for out -of- network services Available funding Full -risk, prospectively rated; also available options self- funded for 250+ life groups Includes* A Healthy Outlook Program' A External Review Policy A Fitness Program A Informed Health" Line A Member Health Education A Women's Health for Life Programs Options* A Employee Assistance Program A National Medical Excellence Program" A Natural Alternatives" Program A Safety Net A Vision One °discount program • *Described in the Programs section of this proposal; brochures also available from your Aetna U.S. Healthcare representative. Visit our website: www.aetnaushc.com 1 I/I7/20(X) • Section 3 - Proposed Benefits 6 City of Sunny Isles USAccess referred benefits may be provided or administered by: Aetna U.S. Healthcare, Inc., Aetna U.S. Healthcare, Inc. (DE), Aetna U.S. Healthcare of California, Inc., Aetna U.S. Healthcare of the Carolinas, Inc., Aetna U.S. Healthcare of Georgia, Inc., Aetna U.S. Healthcare of Illinois, Inc., Aetna U.S. Healthcare of North Texas, Inc, Aetna U.S. Healthcare of Washington, Inc. USAccess self - referred benefits may be provided or administered bv: Aetna U.S. Healthcare, Inc., Aetna U.S. Healthcare of California, Inc., Aetna U.S. Healthcare of the Carolinas, Inc., Aetna U.S. Healthcare of Washington, Inc., Aetna Life Insurance Company, U.S. Health Insurance Company, and/or Corporate Health Insurance" Company. Aetna U.S. Healthcare is a for - profit HMO. This material is for informational purposes only and is neither an offer of coverage nor medical advice. It contains only a partial, general description of plan or program benefits and does not constitute a contract. Consult your Group Agreement and Group Policy to determine governing contractual provisions, including procedures, exclusions and limitations relating to your plan. All the terms and conditions of your plan or program are subject to applicable laws, regulations and policies. The availability of a plan or program may vary by geographic service area. All benefits are subject to coordination of benefits. Aetna U.S. Healthcare does not provide health care services, and therefore cannot guarantee any results or outcomes. Participating providers are independent contractors in private practice and are neither employees nor agents of Aetna U.S. Healthcare or its affiliates. The availability of any particular provider cannot be guaranteed, and provider network composition is subject to change without notice. Certain providers may be affiliated with an Independent Practice Association (IPA), a Physician Medical Group (PMG), an integrated delivery system or other provider groups. Members who select these providers will generally be referred to specialists and hospitals within that system or group. Informed Health Line nurses cannot diagnose, prescribe or give medical advice. Contact your physician first with any questions or concerns regarding your health care needs. The Vision One discount program may be in addition to plan benefits. Providers are solely responsible for the products and services provided under the program. Aetna U.S. Healthcare does not endorse any vendor, product, or service associated with the program. Vision One is a registered trademark of Cole Vision Corporation. Members are responsible for payment for all services or products received through the Natural Alternatives program. Aetna U.S. Healthcare has not credentialed or reviewed program providers or vendors for quality. Program providers are solely the responsible for the products and services provided under the program and encourage members to consult their physician to determine what therapies meet their needs. Not all products offered by program vendors are offered on a reduced -rate basis. Aetna U.S. Healthcare does not endorse any vendor, product or service associated with the programs. While this material is believed to be accurate as of the print date, it is subject to change without notice. In case of conflict between your plan documents and this information, the plan documents will govern. Visit our website: www.aetnaushc.com 11/17/2000 • L J Section 3 - Proposed Benefits City of Sunny Isles Pharmacy " lans With HMO, QPOS`�, USAccess`' and Golden Medicare p Yes; mail -order drub benefits also available Network Yes Copayment Deductibles No Claim Forms No Self - funded, full -risk prospectively rated Funding OPt ons L A full service program that encompasses ons stadard account Featur es management and member service A Drug utilization review to promote safe and appropriate drug use before, during, and after drugs are dispensed. A Formulary programs that encourage physicians to prescribe therapeutically appropriate cost - effective medications. A, One pharmacy claim system for retail and mail order claims, which lowers administrative costs while helping promote safe drug dispensing. A Plan designs that promote quality dispensing and cost savings, along with member choice. convenience and cost- A Simplified plan administration that for c account and member efficiencies of one -stop shopping services. Agreement or does not constitute a contract. Consult your GroupeAa ee to your plan• material is for informational purposes only and is � ither an offer of coverage nor medical advice. it contains only This m ram benefits and partial, general description of plan or program tute a exclusions and limitations go your contractual provisions, inc procedures, Group Policy to determine g ram are subject to applicable laws, regulations and policies. The availability o a All the terms and conditions of your plan or program plan or program may vary by geographic service health care service and therefore°canno�guaranteebany results or outcomes. p agents o Aetna Aetna U.S. Healthcare does not proved private practice and are neither employees nor ag network Participating providers are independent contractors in p P guaranteed, and provider articular provider cannot be g U.S. Healthcare or its affiliates. The availability of any P without notice. lit case of conflict composition is subject to change without notice. Pint date, it is subject to change While this material is believed to be accurate as of the p between your plan documents and this information, the plan documents will govern. a mmaushc.com l 1 / 1712, Section 3 - Proposed Benefits g 41 City of Sunny Isles • Pharmacy With POS, PPO and Indemnity plans Network Yes; mail-order drug options also available Out -of- Network Services Available at a higher copayment for some plans Copayment Yes Deductibles Only for self - funded plans Claim Forms `' Only for out -of- network benefits Funding Options Self - funded, full -risk prospectively rated, split- funded group plan Features A A full service administrative fee that encompasses all standard account management and member service functions. A Drug utilization review to promote, safe appropriate drug use before, during, and after drugs are dispensed. A Formulary programs that encourage physicians to prescribe therapeutically appropriate cost- effective medications. A One pharmacy claim system for retail and mail order claims, which lowers administrative costs while helping promote safe drug dispensing. A Plan designs that promote quality dispensing and cost savings, along with member choice. Quarterly Pharmacy Utilization Reports for self- insured plans that identify drug utilization patterns, determine plan cost effectiveness, and improve plan performance. 1 Savings from substantial retail network and mail order discounts passed in full to self- insured plans and reflected in the premium for insured plans. A Simplified plan administration that provides the convenience and cost - efficiencies of one -stop shopping for account management and member services. Visit our website: www.aetnaushc.com 11/17/2000 Section 3 - Proposed Benefits q • City of Sunny Isles This material is for informational purposes only and is neither an offer of coverage nor medical advice. It contains only a partial, general description of plan or program benefits and does not constitute a contract. Consult your plan documents Group Agreement or Group Policy to determine governing contractual provisions, including procedures, exclusions and limitations relating to your plan. All the terms and conditions of your plan or program are subject to applicable laws, regulations and policies. The availability of a plan or progratn may vary by geographic service area. All benefits are subject to coordination of benefits. Aetna U.S. Healthcare does not provide health care services, and therefore cannot guarantee any results or outcomes. Participating providers are independent contractors in private practice and are neither employees nor agents of Aetna U.S. Healthcare or its affiliates. The availability of any particular provider cannot be guaranteed, and provider network composition is subject to change without notice. While this material is believed to be accurate as of the print date, it is subject to change without notice. In case of conflict between your plan documents and this information, the plan documents will govern. • • Visit our website: www.aetnaushc.com 11/17/2000 Section 3 - Proposed Benefits 10 • City of Sunny Isles Vision Prescription A low -cost benefit for eyewear available as an option for HMO, QPOS® Eyewear Rider and USAccess® Network* Yes Out -of- Network Services Yes Claim Forms Only if out -of- network i Funding Options Full -risk prospectively rated Features A Generally decreases member out -of- pocket expense A Included in every health plan, excluding Family Care and New Jersey MdCare * Members can go out -of- network to visit any licensed provider (subject to plan exclusions and limitations), but using Vision One location generally lowers member's out of pocket expense. This material is for informational purposes only and is neither an offer of coverage nor medical advice. It contains only a • partial, general description of plan or program benefits and does not constitute a contract. All the terms and conditions of your plan or program are subject to applicable laws, regulations and policies. The availability of a plan or program may vary by geographic service area. Aetna U.S. Healthcare does not provide health care services, and therefore cannot guarantee any results or outcomes. Participating providers are independent contractors in private practice and are neither employees nor agents of Aetna U.S. Healthcare or its affiliates. The availability of any particular provider cannot be guaranteed, and provider network composition is subject to change without notice. While this material is believed to be accurate as of the print date, it is subject to change without notice. In case of conflict between your plan documents and this information, the plan documents will govern. Visit our website: www.iietnaushc.com 11/17/2000 Section 3 - Proposed Benefits I 1 City of Sunny Isles • f � Basic Vision - An option for EPO, POS, PPO and Indemnity Scheduled Benefit Network* Yes ' Out -of- Network Services Yes Copayment Does not apply Funding Options Self - funded Features A Flexibility in maximums, benefit periods A No separate eligibility submission required * Members can go out -of- network to visit any licensed provider (subject to plan exclusions and limitations), but using Vision One location generally lowers member's out of pocket expense. This material is for informational purposes only and is neither an offer of coverage nor medical advice. /t contains only a partial, general description of plan or program benefits and does not constitute a contract. All the terms and conditions of your plan or program are subject to applicable laws, regulations and policies. The availability of a plan or program may vary by geographic service area. Aetna U.S. Healthcare does not provide health care services, and therefore cannot guarantee any results or outcomes. Participating providers are independent contractors in private practice and are neither employees nor agents of Aetna U.S. Healthcare or its affiliates. The availability of any particular provider cannot be guaranteed, and provider network composition is subject to change without notice. While this material is believed to be accurate as of the print date, it is subject to change without notice. In case of conflict between your plan documents and this information, the plan documents will govern. Visit our website: www.aetnaushc.com 11/17/2000 To pT�n easons To Choose Aetna U.S. Healthcare 1. DocFind* — Updated three times a week, our online provider directory helps you locate participating providers, including primary care physicians, specialists, dentists, hospitals and pharmacies by clicking on DocFind on our website (www aetnaushc.com). 2. Wellness and Cancer Screening Programs — Our wellness programs help you meet personal health goals, such as developing good nutritional habits and quitting smoking. Our breast, cervical and colorectal cancer screening programs help to detect cancer in its early stages. 3. Electronic Referrals — Many participating providers can now forward referrals to your specialist electronically — eliminating the need for paper referrals. With electronic referrals in place, providers can utilize our innovative E- Pay'" system to submit claims electronically, resulting in more accurate and timely processing and payment. 4. Informed Health* Line* — Staying informed is one step you can take toward meeting the challenge to stay healthy. Our 24 -hour toll-free Informed Health Line is your direct link to a team of experienced registered nurses who can provide health information, coaching and support on a variety of health issues — anytime, day or night. 5. Women's Health for Life Programs — Female members can take part in programs designed to promote their health and well-being from adolescence through the senior years. These programs include direct access to participating gynecological providers; the L'il Appleseed* Maternity Management Program; nurse case management; a menopause program that offers annual osteoporosis screening; educational information on staying healthy and avoiding health risks, and more. 6. InteliHealth® — From the Aetna U.S. Healthcare website (www aetnaushc.com), link to the award - winning InteliHealth website (www.intelihealth.com). Visit InteliHealth to complete a personal Health Risk Report and get health information, along with nutrition and fitness tips. Members can also get discounts on products through the online InteliHealth Healthy Home° store when they link to InteliHealth through the Aetna U.S. Healthcare site. 7. Healthy Outlook Program® — This program helps partici- pating providers identify, monitor and educate members with chronic conditions like asthma, heart failure, diabetes or low back pain, helping members to learn to better manage these conditions and improve their quality of life. Nurse case managers monitor patient progress and members receive screening reminders and disease - specific educational materials. 8. Three Easy -to -Use Programs The Vision One® ** discount program offers you discounts on eyewear and related products. The Natural Alternatives" program offers you savings on acupuncture, chiropractic care, nutritional supplements and massage therapy. The Fitness program provides special membership rates on health clubs and savings on home exercise equipment. 9. National Medical Excellence Program* — Through this unique program, we provide eligible members with access to nationally respected physicians and facilities if treatment for a complex illness or injury is not available locally. When precertified, care will be covered (less applicable copayments). Related transportation expenses may also be covered, including an allowance for a companion. 10. Coverage for Out -of -Area Dependents — You can relax knowing that your eligible dependents have the same quality protection you do — even if they live away from home. If your eligible dependents live within another Aetna U.S. Healthcare HMO service area, they can choose a participating provider in their own service area. *Informed Health Line nurses cannot diagnose, prescribe or give medical advice. Contact your physician with any questions or concerns regarding your health care needs. * *Vision One is a registered trademark of Cale Vision. Aetna U.S. Healthcare is a for - profit HMO. This material is for informational purposes only and is neither an offer of coverage nor medical advice. It contains only a partial, general description of plan or program benefits and does not constitute a contract. Consult your plan documents (Schedule of Benefits, Certificate of Coverage, Group Insurance Certificate) to determine governing contractual provisions, including procedures, exclusions and limitations relating to your plan. All the terms and conditions of your plan or program are subject to applicable laws, regulations and policies. The availability of a plan or program may vary by geographic service area. All benefits are subject to coordination of benefits. Aetna U.S. Healthcare does not provide health care services and, therefore, cannot guarantee any results or outcomes. Participating providers and agency nurses are independent contractors in private practice and are neither employees nor agents of Aetna U.S. Healthcare or its affiliates. The availability of any particular provider cannot be guaranteed, and provider network composition is subject to change without notice. Natural Alternatives and Vision One, discount -only programs, and the Fitness program, a rate - access program, may be in addition to any plan benefits. Natural Alternatives, Vision One and Fitness providers are solely responsible for the products and services provided under the discount program. Aetna U.S. Healthcare does not endorse any vendor, product or service associated with these programs. Benefits may be provided or administered by: Aetna U.S. Healthcare Inc., Aetna U.S. Healthcare Inc. (DE), Aetna U.S. Healthcare of California Inc., Aetna U.S. Healthcare of the Carolinas Inc., Aetna U.S. Healthcare of Georgia Inc., Aetna U.S. Healthcare of Illinois Inc., Aetna U.S. Healthcare of North Texas Inc., Aetna U.S. Healthcare of Washington Inc., Aetna Life Insurance Company, U.S. Health Insurance Company and /or Corporate Health Insurance" Company. The information in this document is subject to change without notice. In case of a conflict between your plan documents and this information, the plan documents will govern. [Atna US Healthcare' 0077 -5/00 ©2000 Aetna U.S. Healthcare Inc. • • Option 9 EyeMed Vision PROPOSAL FORM City of Sunny Isles Beach Bid #00 -11 -01 Group Vision' Insurance Coverage We propose the following rate structure: Group Health Insurance PPO Program, consistent with the City specifications and details provided by the bidder on attached sheets. Cost per month, per employee: $5.07 employee $9.64 employee + child $9.64 employee + spouse $14.19 employee + family We propose the following for covered Dental Expense: Calendar year deductible per participant Calendar year maximum per participant Preventive Basic Restoration & Specialty Orthodontia We propose the following for Vision Caieo Exam $10 Lenses See Attached Frames See Attached Contacts ,;Ptn A_ .a h d We propose the following for Prescription Drugs: In Network, Generic Brand Name Out of Network Non - Formulary The City reserves the right to reject any and all bids. Final rates based upon enrollment census ¢ carrier underwriting.